AGES XXIII Annual Scientific Meeting 2013 Abstracts & Program

AGES XXIII Annual Scientific Meeting 2013
Free Communications Chairmen’s Choice - Friday 8 March
SESSION 7 - Free COMMUNICATIONS
Chairmen’s Choice / 1440-1450
Depot medroxyprogesterone acetate (DMPA) in
the treatment of endometriosis
Vollenhoven B, Dennerstein G, Fernando S, Fraser
I, Polyakov A, Vu P, Wark JD
This is an account of 141 consecutive women diagnosed with
endometriosis and treated with DMPA injections between
1973 and 2011 in one gynaecological private practice.
The data were collected prospectively and entered in a
purpose-made database. Many individuals were treated over
prolonged periods of time. Dosages were given according to
recommended schedules for endometriosis, usually 150mg
every 3 months.
The data have been analyzed with regard to duration and
success of the treatment and side effects, including the effect
on bone mineral density.
Pelvic pain was relieved with a high degree of success and
limited side-effects (in line with published data). Bone
mineral density measurements show no significant difference
from a normal female population collected in the same city
using the same hospital-based BMD practice.
It is concluded that DMPA is a safe and effective treatment
that should be offered as an alternative long-term medical
option to all women diagnosed with endometriosis who do
not wish to conceive within 12 to 18 months. Published data
on this option are very limited, but anecdotally it is used
widely around the world for endometriosis.
AUTHOR AFFILIATION: B. Vollenhoven 1 , G. Dennerstein 2 ,
S. Fernando 1 , I. Fraser 3 , A. Polyakov 4 , P. Vu 1 , J. D. Wark 5 ;
1. Monash Medical Centre, Clayton, Victoria, Australia.
2. Melbourne University, Melbourne, Victoria, Australia.
3. Sydney University, Sydney, New South Wales, Australia.
4. Melbourne IVF, East Melbourne, Victoria, Australia.
5. Royal Melbourne Hospital, Parkville, Victoria, Australia.
SESSION 7 - Free COMMUNICATIONS
Chairmen’s Choice / 1450-1500
Retrospective clinical audit reviewing the use of
Magnetic Resonance guided Focused Ultrasound
(MRgFUS) in the treatment of submucosal uterine
fibroids at the Royal Women’s Hospital Melbourne
Rajadevan N, Szabo R, Dobrotwir A, Ang WC
of fibroids is increasing, effective treatment options which
relieve symptoms whilst also preserving fertility are
becoming increasingly more important. MRgFUS provides
one such treatment alternative.
AIM: To review all cases of submucosal uterine fibroids
treated by MRgFUS at the Royal Women’s Hospital
Melbourne between 2009-2012 over the first 30 months of
MRgFUS related experience. Specific outcomes assessed
included treatment success as defined by a reduction in
symptom severity score measured at 4 and 12 months posttreatment,
fibroid volume shrinkage and features predictive
of treatment failure.
METHODS: A retrospective clinical audit was undertaken
of 62 women who underwent treatment with MRgFUS for
at least one submucosal fibroid over the initial 30 month
treatment period at the Royal Women’s Hospital Melbourne.
Patients were identified through a database maintained by
the Radiology department and data regarding demographics,
clinical characteristics and treatment outcomes was obtained
through the clinical results database and individual patient
hospital records.
RESULTS: Of the 62 patients identified, 39 (62.9%) of
patients were successfully treated by MRgFUS with a
decrease in symptom severity score at 4 months whilst at 12
months 32 (59.3%) of patients were considered to have been
successfully treated. Ten patients (16.1%) required further
intervention despite treatment with MRgFUS including
either hysterectomy or open, laparoscopic or hysteroscopic
myomectomy. Patients who failed MRgFUS treatment were
more likely to be of a younger age (40.4 vs 42.7yrs), decreased
parity (0.6 vs 1.1) and with an increased overall uterine and/
or fibroid volume (mean uterine volume 520.8 vs 490.8mL).
Overall reduction in treated fibroid volume also varied
between those who were treated successfully in comprison to
those who failed treatment.
CONCLUSION: In selected cases for the treatment of
submucosal fibroids MRgFUS provides a safe and suitable
treatment alternative. Whilst further studies are required
to more fully determine long-term outcomes and optimal
patient characteristics, the benefits of MRgFUS over other
treatment modalities include its non-invasive nature,
relatively low complication rate, quicker recovery and
preservation of fertility.
AUTHOR AFFILIATION: N. Rajadevan, R. Szabo, A.
Dobrotwir, W. C. Ang; Royal Women’s Hospital Parkville,
Victoria, Australia.
BACKGROUND: Uterine fibroids are hormonally dependent
with a maximal incidence during the reproductive years
and are reported to occur in 20-40% of reproductive aged
women and are clinically apparent in approximately 12-25%.
Symptoms attributable to uterine fibroids are generally
classified into three categories: abnormal uterine bleeding,
pelvic pressure and pain and reproductive dysfunction. A
number of treatment alternative are available. However,
given the tendency for women to start a family at an age
where natural female fertility is in decline and the incidence
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